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Organization
CROSSROADS PHYSICIAN CORP
Active
Organization
CROSSROADS PHYSICIAN CORP
Active
Parent organization
CROSSROADS PHYSICIAN CORP
Other names
Crossroads Family Medicine of Mt Vernon
Organization subpart
Yes
Provider details
NPI number
Legal business name
CROSSROADS PHYSICIAN CORP
Authorized official
DEBBIE BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(615) 465-7626
Entity
Organization
Contact information
Practice address
3505 BROADWAY ST, MOUNT VERNON, IL 62864-2202
(618) 241-8772
(618) 241-8775
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7626
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
NULL
Other
Enumeration date
09/06/2005
Last updated
08/10/2011
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